Issues That Should Be Discussed and Considered Include but Are Not Limited To

DNA TESTING FOR HUNTINGTON DISEASE

DNA testing for Huntington’s Disease (HD) is not for everyone. There are many practical and ethical issues that should be considered before testing for HD. For this reason, both the Huntington’s Disease Society of America (HDSA) and the American Academy of Neurology (AAN) have developed recommendations and guidelines regarding pretest counseling for use by you and your patient.

Issues that should be discussed and considered include but are not limited to:

 The reliability of the test results.  The ramifications of a positive or negative result on you and your family members.  Life and health insurance coverage  Coping strategies and support network when results are reported.

I am familiar with the practice guidelines of the Huntington’s Disease Society of America (HDSA) and the American Academy of Neurology (AAN) and have discussed the benefits, limitations, and ramifications of HD testing with my patient and have received consent.

Patient Name: ______DOB:______

Physician Name______Date:______

Signature of Physician ______

Physician telephone______Physician fax ______Purpose of Testing: Please check one  Patient is symptomatic  Patient has no symptoms, has positive family history

Information and Educational materials regarding presymptomatic testing for HD may be obtained through several websites: www.hdsa.org www.nsgc.org www.acmg.net

For further questions, please call one of our genetic counselors at 1-866-GENE-INFO (1- 866-436-3463).

Please fax this signed document back to (949) 728-4874 ATTN: Molecular Genetics’ Genetic Counselor OR (610) 271-9734 ATTN: Chantilly send-out dept

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